Abstract As a clinician dedicated to integrating cutting-edge, evidence-based therapies, I continually explore innovative methods to address complex musculoskeletal conditions. In this educational post, we will journey into the advanced technique of High-Volume Injection (HVI) , also known as brisement , a powerful tool for managing chronic tendinopathies. Drawing on the latest research and clinical expertise, I will explain the physiological principles behind this procedure, its application for conditions like Achilles and patellar tendinopathy, and how it represents a significant leap forward from traditional treatments. We'll explore the "why" and "how" of HVI, detailing hydrostatic tissue decompression and the disruption of pain-generating neovessels and neonerves. This post aims to provide a clear, easy-to-understand guide for patients and practitioners alike, illuminating how this modern intervention integrates into a comprehensive care plan, such as the o...
Abstract In this educational post, I walk you through a modern, ultrasound-guided approach to treating calcific tendinopathy using barbotage —a technique of repeated needle fenestration, injection, and aspiration to dissolve and evacuate pathologic calcium deposits. I explain how the procedure works physiologically, why it reduces pain and restores function, and how we tailor the approach for soft versus hard calcifications using single-needle and two-needle circuits. I present current evidence, clinical nuances, and practical setup steps. I also describe our multidisciplinary care model at Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic) in El Paso, Texas, where I collaborate with Dr. Maria Guadalupe Cardenas, MD (Board Certified in Internal Medicine; NPI #1164426749; Texas MD License #J2933) as our Medical Director and Collaborative Physician. Together, we combine integrative chiropractic , internal medicine oversight , functional medicine , personal injury care , and...
